Multimorbidity in bipolar disorder and under-treatment of cardiovascular disease: a cross sectional study

Background: Individuals with serious mental disorders experience poor physical health, especially increased rates of cardiometabolic morbidity and premature morbidity. Recent evidence suggests that individuals with schizophrenia have numerous comorbid physical conditions which may be under-recorded and under-treated but to date very few studies have explored this issue for bipolar disorder. Methods:We conducted a cross-sectional analysis of a dataset of 1,751,841 registered patients within 314 primary-care practices in Scotland, U.K. Bipolar disorder was identified using Read Codes recorded within electronic medical records. Data on 32 common chronic physical conditions were also assessed. Potential prescribing inequalities were evaluated by analyzing prescribing data for coronary heart disease (CHD) and hypertension. Results: Compared to controls, individuals with bipolar disorder were significantly less likely to have no recorded physical conditions (OR 0.59, 95% CI 0.54-0.63) and significantly more likely to have one physical condition (OR 1.27, 95% CI 1.16-1.39), two physical conditions (OR 1.45, 95% CI 1.30-1.62) and three or more physical conditions (OR 1.44, 95% CI 1.30-1.64). People with bipolar disorder also had higher rates of thyroid disorders, chronic kidney disease, chronic pain, chronic obstructive airways disease and diabetes but, surprisingly, lower recorded rates of hypertension and atrial fibrillation. People with bipolar disorder and comorbid CHD or hypertension were significantly more likely to be prescribed no antihypertensive or cholesterol-lowering medications compared to controls, and bipolar individuals with CHD or hypertension were significantly less likely to be on 2 or more antihypertensive agents. Conclusions: Individuals with bipolar disorder are similar to individuals with schizophrenia in having a wide range of comorbid and multiple physical health conditions. They are also less likely than controls to have a primary-care record of cardiovascular conditions such as hypertension and atrial fibrillation. Those with a recorded diagnosis of CHD or hypertension were less likely to be treated with cardiovascular medications and were treated less intensively. This study highlights the high physical healthcare needs of people with bipolar disorder, and provides evidence for a systematic under-recognition and under-treatment of cardiovascular disease in this group

Design and fabrication of dioxyphenylcoumarin substituted cyclotriphosphazene compounds photodiodes

The present study introduces cyclotriphosphazene compounds substituted by dioxyphenylcoumarin as a photodiode application. Firstly, 7,8-dihydroxy-3-(3-methylphenyl)coumarin (1b) has been obtained by conventional as well as microwave assisted methods. Novel optoelectronic device characteristics for both mono and disubstituted dioxyphenylcoumarin bearing cyclotriphosphazene compounds (HCP-2 and HCP-4) have been synthesized from the reactions of cyclotriphosphazene containing dioxybiphenyl (HCP-1 and HCP-3) with compound 1b, respectively. The structures of compounds HCP 1–4 were identified by using elemental analysis, 1H, 13C-APT, 31P NMR and 2D HETCOR NMR and FT-IR spectroscopy methods. The Al/HCP-2/p-Si/Al and Al/HCP-4/-p-Si/Al photodiodes properties have been investigated from current-voltage (I−V) and capacitance-voltage (C−V) measurements. The electrical parameters of the prepared diodes such as ideality factor n and series resistance Rs were investigated in dark and at room temperature from (I−V) curve and Nord's method. As can be seen, the Al/HCP-2/p-Si/Al diode of high rectification ratio RR and with ideality factor greater than unity. The influence of light illuminations on the diode shows that the device can be used as photodiode with good efficiency. The barrier height ϕb and series resistance Rs have been calculated from the capacitance-voltage (C−V)and conductance-voltage (G−V) measurements under various applied frequencies from 10 kHz to 1 MHz. the high difference in the results of barrier height obtained from I-V and C-V calculations confirm the influence of series resistance and localized states on transport of charge carriers and the photodiode performance.TUBITAK-110T652 Fırat University, FÜBAP-FF.161

Compulsive buying and branding phenomena

The purpose of this paper was to explore the impact of brand variables such as brand awareness, brand loyalty, brand attachment, and perceived brand quality on compulsive buying behavior. A self-administered questionnaire, containing demographic items and items related to compulsive buying, brand awareness, brand loyalty, brand attachment and perceived quality, was used to collect data. Participants were 269 US university students at a large mid-western university (138 men, 131 women; mean age = 21.96). Data were analyzed using descriptive statistics, t-test and MANOVA/ANOVA. Reliability of all scales was acceptable. In the current study, 18% of the participants were classified as compulsive buyers. Women showed higher compulsive buying tendency than men. Participants with greater compulsive buying tendency scored higher on brand attachment and brand loyalty and lower on brand awareness; there was no difference in scores on perceived brand quality. Results support that brand variables such as brand awareness, brand loyalty, and brand attachment are related to compulsive buying behavior. New perceptions and implications for both academicians and practitioners are provided

Quetiapine augmentation of SRIs in treatment refractory obsessive-compulsive disorder: a double-blind, randomised, placebo-controlled study [ISRCTN83050762]

BACKGROUND: Although serotonin reuptake inhibitors are effective in the treatment of OCD, many patients fail to respond to these agents. Growing evidence from open-label and placebo-controlled trials suggests a role for augmentation of SRIs with atypical antipsychotics in OCD. Quetiapine is generally well tolerated and previous open-label data has produced mixed results in OCD and additional controlled data is needed. METHODS: We undertook a double-blind, randomised, parallel-group, flexible-dose, placebo-controlled study of quetiapine augmentation in subjects who had responded inadequately to open-label treatment with an SRI for 12 weeks. Following informed consent and screening, forty-two subjects were randomised to either placebo or quetiapine for six weeks. RESULTS: There was significant improvement from baseline to endpoint on the Yale-Brown Obsessive-Compulsive Scale in both the quetiapine and placebo groups (quetiapine, n = 20, p < 0.0001; placebo, n = 21, p = 0.001) with 40% (n = 8) of quetiapine and 47.6% (n = 10) of placebo treated subjects being classified as responders. Quetiapine did not demonstrate a significant benefit over placebo at the end of the six-week treatment period (p = .636). Similarly quetiapine failed to separate from placebo in the subgroup of subjects (n = 10) with co-morbid tics. Quetiapine was generally well tolerated. CONCLUSIONS: In this study, quetiapine augmentation was no more effective than placebo augmentation of SRIs. A number of limitations in study design make comparisons with previous studies in this area difficult and probably contributed to our negative findings. Future work in this important clinical area should address these limitations

Proteome-wide analysis identifies plasma immune regulators of amyloid-beta progression

While immune function is known to play a mechanistic role in Alzheimer's disease (AD), whether immune proteins in peripheral circulation influence the rate of amyloid-β (Aβ) progression - a central feature of AD - remains unknown. In the Baltimore Longitudinal Study of Aging, we quantified 942 immunological proteins in plasma and identified 32 (including CAT [catalase], CD36 [CD36 antigen], and KRT19 [keratin 19]) associated with rates of cortical Aβ accumulation measured with positron emission tomography (PET). Longitudinal changes in a subset of candidate proteins also predicted Aβ progression, and the mid- to late-life (20-year) trajectory of one protein, CAT, was associated with late-life Aβ-positive status in the Atherosclerosis Risk in Communities (ARIC) study. Genetic variation that influenced plasma levels of CAT, CD36 and KRT19 predicted rates of Aβ accumulation, including causal relationships with Aβ PET levels identified with two-sample Mendelian randomization. In addition to associations with tau PET and plasma AD biomarker changes, as well as expression patterns in human microglia subtypes and neurovascular cells in AD brain tissue, we showed that 31 % of candidate proteins were related to mid-life (20-year) or late-life (8-year) dementia risk in ARIC. Our findings reveal plasma proteins associated with longitudinal Aβ accumulation, and identify specific peripheral immune mediators that may contribute to the progression of AD pathophysiology

Review of Dental Impression Materials

Major advances in impression materials and their application have occurred during the last decade, with greater emphasis being placed on rubber impression materials than on dental compound, zinc oxide-eugenol, and agar and alginate. Of particular interest has been the effect of disinfection solutions on the qualities of impressions and the biocompatibility of impression materials. The principal advance in hydrocolloids has been the introduction of the agar/alginate impression technique, which has simplified the procedure and improved the quality of gypsum dies compared with those prepared in alginate impressions. The tear strength of some alginates has been improved, and some have been formulated so that the powder is dustless, thus reducing the health hazard as a result of patient inhalation of dust during the dispensing process. Polyether and silicone impression materials have been modified so that the working time, viscosity, and flexibility of the polyethers have been improved and, with the introduction of addition silicones, their accuracy has become exceptional. Although the early addition silicones liberated hydrogen after setting, thus delaying the pouring of models and dies, most addition silicones have been improved so that no hydrogen is released and dies can be poured immediately. The introduction of automatic mixing systems for addition silicones has simplified their manipulation, has reduced the number of voids in impressions, and has reduced the amount of material wasted. The incorporation of surfactants into addition silicones has made them hydrophilic, with wetting properties similar to those of polyethers, and has made pouring bubble-free gypsum dies easier. This review is confined to published and unpublished information of the past decade. It will also suggest trends that should be anticipated in the near future based on this information. The review will not present information developed before 1975, which is available in several textbooks on dental materials by Craig (1985a), Phillips (1982), and Williams and Cunningham (1979).Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/66604/2/10.1177_08959374880020012001.pd

Effects of STN and GPi Deep Brain Stimulation on Impulse Control Disorders and Dopamine Dysregulation Syndrome

Impulse control disorders (ICDs) and dopamine dysregulation syndrome (DDS) are important behavioral problems that affect a subpopulation of patients with Parkinson's disease (PD) and typically result in markedly diminished quality of life for patients and their caregivers. We aimed to investigate the effects of subthalamic nucleus (STN) and internal globus pallidus (GPi) deep brain stimulation (DBS) on ICD/DDS frequency and dopaminergic medication usage.A retrospective chart review was performed on 159 individuals who underwent unilateral or bilateral PD DBS surgery in either STN or GPi. According to published criteria, pre- and post-operative records were reviewed to categorize patients both pre- and post-operatively as having ICD, DDS, both ICD and DDS, or neither ICD nor DDS. Group differences in patient demographics, clinical presentations, levodopa equivalent dose (LED), and change in diagnosis following unilateral/bilateral by brain target (STN or GPi DBS placement) were examined.28 patients met diagnostic criteria for ICD or DDS pre- or post-operatively. ICD or DDS classification did not differ by GPi or STN target stimulation. There was no change in DDS diagnosis after unilateral or bilateral stimulation. For ICD, diagnosis resolved in 2 of 7 individuals after unilateral or bilateral DBS. Post-operative development of these syndromes was significant; 17 patients developed ICD diagnoses post-operatively with 2 patients with pre-operative ICD developing DDS post-operatively.Unilateral or bilateral DBS did not significantly treat DDS or ICD in our sample, even though a few cases of ICD resolved post-operatively. Rather, our study provides preliminary evidence that DDS and ICD diagnoses may emerge following DBS surgery

Efficacy of tissue brushing as measured by the prosthodontic tissue index

This study was conducted to determine the efficacy of brushing the oral mucosa supporting complete dentures with a soft brush to see if this treatment would reduce inflammation. The oral mucosa health status of 60 patients was monitored for 120 days using the PTI to measure inflammation. For comparison the patients were divided into two groups, and every effort was made to balance the groups for those variables that may effect inflammation. The patients were also compared with themselves. The experiment consisted of three phases; Phase 1 established baseline data, and Phases 2 and 3 were information-gathering sessions. Each patient received brushing instructions at the start of the brushing test period and additional brushing instruction during a reinforcement session after 30 days. Tissue brushing did reduce the inflammation index of the oral mucosa examined.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/74782/1/j.1754-4505.1984.tb00150.x.pd

A comparison of nefazodone, the cognitive behavioral-analysis system of psychotherapy, and their combination for the treatment of chronic depression

Background Patients with chronic forms of major depression are difficult to treat, and the relative efficacy of medications and psychotherapy is uncertain. Methods We randomly assigned 681 adults with a chronic nonpsychotic major depressive disorder to 12 weeks of outpatient treatment with nefazodone (maximal dose, 600 mg per day), the cognitive behavioral-analysis system of psychotherapy (16 to 20 sessions), or both. At base line, all patients had scores of at least 20 on the 24-item Hamilton Rating Scale for Depression (indicating clinically significant depression). Remission was defined as a score of 8 or less at weeks 10 and 12. For patients who did not have remission, a satisfactory response was defined as a reduction in the score by at least 50 percent from base line and a score of 15 or less. Raters were unaware of the patients’ treatment assignments. Results Of the 681 patients, 662 attended at least one treatment session and were included in the analysis of response. The overall rate of response (both remission and satisfactory response) was 48 percent in both the nefazodone group and the psychotherapy group, as compared with 73 percent in the combined-treatment group (P Conclusions Although about half of patients with chronic forms of major depression have a response to short-term treatment with either nefazodone or a cognitive behavioral-analysis system of psychotherapy, the combination of the two is significantly more efficacious than either treatment alone